. 2022 Dec;10(12):e1825-e1834.

doi: 10.1016/S2214-109X(22)00424-7.

The HIV and sexually transmitted infection syndemic following mass scale-up of combination HIV interventions in two communities in southern Uganda: a population-based cross-sectional study

M Kate Grabowski¹, Josephine Mpagazi², Stephen Kiboneka², Robert Ssekubugu², John Baptiste Kereba², Annet Nakayijja², Julius Tukundane², Jade C Jackson³, Austin D Peer⁴, Caitlin Kennedy⁵, Godfrey Kigozi², Ronald M Galiwango², Yukari C Manabe⁶, Larry W Chang⁷, Sarah Kalibala², Ronald H Gray⁸, Maria J Wawer⁸, Steven J Reynolds⁹, Aaron A R Tobian¹⁰, David Serwadda¹¹, Charlotte A Gaydos⁶, Joseph Kagaayi¹², Thomas C Quinn⁹; Rakai Health Sciences Program

Collaborators, Affiliations

Collaborators

Rakai Health Sciences Program:
Dorean Nabukalu, Anthony Ndyanabo, Joseph Ssekasanvu, Hadijja Nakawooya, Jessica Nakukumba, Grace N Kigozi, Betty S Nantume, Nampijja Resty, Jedidah Kambasu, Margaret Nalugemwa, Regina Nakabuye, Lawrence Ssebanobe, Justine Nankinga, Adrian Kayiira, Gorreth Nanfuka, Ruth Ahimbisibwe, Stephen Tomusange, Ronald M Galiwango, Margaret Nakalanzi, Aisha Nalukwago, Joseph Ouma Otobi, Denis Ankunda, Joseph Lister Ssembatya, John Baptist Ssemanda, Robert Kairania, Emmanuel Kato, Alice Kisakye, James Batte, James Ludigo, Abisagi Nampijja, Steven Watya, Kighoma Nehemia, Sr Margaret Anyokot, Joshua Mwinike, George Kibumba, Paschal Ssebowa, George Mondo, Francis Wasswa, Agnes Nantongo, Rebecca Kakembo, Josephine Galiwango, Geoffrey Ssemango, Andrew D Redd, John Santelli, Oliver Laeyendecker, John Santelli, Jennifer Wagman, Rey Fernandez, Nelson Sewankambo, Yasmin Ogale

Affiliations

¹ Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda. Electronic address: mgrabow2@jhu.edu.
² Rakai Health Sciences Program, Kalisizo, Uganda.
³ Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁴ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda.
⁶ Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁷ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁸ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda.
⁹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MA, USA.
¹⁰ Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹¹ Rakai Health Sciences Program, Kalisizo, Uganda; Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
¹² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.

PMID: 36400088
PMCID: PMC10068679
DOI: 10.1016/S2214-109X(22)00424-7

The HIV and sexually transmitted infection syndemic following mass scale-up of combination HIV interventions in two communities in southern Uganda: a population-based cross-sectional study

M Kate Grabowski et al. Lancet Glob Health. 2022 Dec.

. 2022 Dec;10(12):e1825-e1834.

doi: 10.1016/S2214-109X(22)00424-7.

Authors

Collaborators

Rakai Health Sciences Program:
Dorean Nabukalu, Anthony Ndyanabo, Joseph Ssekasanvu, Hadijja Nakawooya, Jessica Nakukumba, Grace N Kigozi, Betty S Nantume, Nampijja Resty, Jedidah Kambasu, Margaret Nalugemwa, Regina Nakabuye, Lawrence Ssebanobe, Justine Nankinga, Adrian Kayiira, Gorreth Nanfuka, Ruth Ahimbisibwe, Stephen Tomusange, Ronald M Galiwango, Margaret Nakalanzi, Aisha Nalukwago, Joseph Ouma Otobi, Denis Ankunda, Joseph Lister Ssembatya, John Baptist Ssemanda, Robert Kairania, Emmanuel Kato, Alice Kisakye, James Batte, James Ludigo, Abisagi Nampijja, Steven Watya, Kighoma Nehemia, Sr Margaret Anyokot, Joshua Mwinike, George Kibumba, Paschal Ssebowa, George Mondo, Francis Wasswa, Agnes Nantongo, Rebecca Kakembo, Josephine Galiwango, Geoffrey Ssemango, Andrew D Redd, John Santelli, Oliver Laeyendecker, John Santelli, Jennifer Wagman, Rey Fernandez, Nelson Sewankambo, Yasmin Ogale

Affiliations

¹ Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda. Electronic address: mgrabow2@jhu.edu.
² Rakai Health Sciences Program, Kalisizo, Uganda.
³ Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁴ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda.
⁶ Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁷ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁸ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda.
⁹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Rakai Health Sciences Program, Kalisizo, Uganda; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MA, USA.
¹⁰ Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹¹ Rakai Health Sciences Program, Kalisizo, Uganda; Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
¹² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.

PMID: 36400088
PMCID: PMC10068679
DOI: 10.1016/S2214-109X(22)00424-7

Abstract

Background: Combination HIV prevention and treatment interventions (CHIs) have led to substantial declines in HIV incidence in sub-Saharan Africa; however, population-level data on non-HIV sexually transmitted infections (STIs) in the context of CHIs are rare. We aimed to assess STI burden following scale-up of CHIs in Uganda.

Methods: The Sexually Transmitted Infection Prevalence Study (STIPS) was a cross-sectional study nested within a population-based cohort among inland agrarian and Lake Victoria fishing populations in southern Uganda. STIPS enrolled consenting residents aged 18-49 years in two communities (one inland and one fishing) between May and October, 2019, and measured the prevalence of chlamydia, gonorrhoea, trichomonas, syphilis, and herpes simplex virus 2 (HSV-2).

Findings: Between May 27, 2019 and Oct 25, 2019, STIPS enrolled 1825 participants. HIV prevalence was 14·0% among the inland population and 39·8% among the fishing population, with about 90% HIV viral load suppression in both communities. Among inland and fishing populations, chlamydia prevalence was 9·6% (95% CI 7·9-11·7) and 9·9% (8·1-12·0), gonorrhoea prevalence 5·0% (3·8-6·7) and 8·4% (6·8-10·5), trichomonas prevalence 9·4% (7·7-11·5) and 12·2% (10·2-14·5), and HSV-2 prevalence 43·0% (39·9-46·3) and 64·4% (61·3-67·6), respectively. In the fishing population, syphilis seropositivity was 24·2% (21·5-27·2) with 9·4% (7·7-11·5) having high-titre (rapid plasma reagin ≥1:8) infection, including 16·9% (11·9-24·0%) of men living with HIV. Prevalence of at least one curable STI (chlamydia, gonorrhoea, trichomonas, or high-titre syphilis) was 51% higher among people living with HIV (vs HIV negative; adjusted prevalence risk ratio [PRR] 1·51; 95% CI 1·27-1·78), including among pregnant women (adjusted PRR 1·87, 1·11-3·17), with no differences by HIV suppression status.

Interpretation: Despite near universal HIV treatment, STI burden remains extremely high in southern Uganda, particularly among people living with HIV. There is an urgent need to integrate STI care with HIV services in African settings.

Funding: National Institutes of Health.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests MJW and RHG are paid consultants to the Rakai Health Sciences Program and serve on its Board of Directors. These arrangements have been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. YCM has received grant support to John Hopkins University from Hologic, Cepheid, Roche, ChemBio, Becton Dickinson, and miDiagnostics, and has provided consultative support to Abbot. All other authors declare no competing interests.

Figures

**Figure 1.. Enrollment of 1,825 participants into the Sexually Transmitted infection Prevalence Study (STIPS) through the Rakai Community Cohort Study (RCCS).**
All percentages are reported as a proportion (times 100) among those verified as eligible for the RCCS.

**Figure 2.. Chlamydia (CT), gonorrhea (NG), and trichomonas (TV) prevalence among 1,825 STIPS participants in southern Uganda stratified by age, gender, and community.**
Bars represent 95% confidence intervals.

**Figure 3.. HSV-2 and syphilis (positive serology and high titer) prevalence among 1,825 STIPS participants in southern Uganda stratified by age, gender, and community.**
Bars represent 95%CI confidence intervals.

See this image and copyright information in PMC

Comment in

Alarming high prevalence of non-HIV sexually transmitted infections in a rural population of Southern Uganda.
Gómez-Olivé FX, Scheuermaier K. Gómez-Olivé FX, et al. Lancet Glob Health. 2022 Dec;10(12):e1701-e1702. doi: 10.1016/S2214-109X(22)00474-0. Lancet Glob Health. 2022. PMID: 36400077 No abstract available.

References

1. World Health Organization. Sexually Transmitted Infections Fact Sheet. 2021; published online Nov 22. http://who.int/news-room/fact-sheets/detail/sexually-transmitted-infecti... (accessed Jan 20, 2022). - PubMed
1. GBD 2017 HIV collaborators. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. Lancet HIV 2019; 6: e831–e859. - PMC - PubMed
1. Zheng Y, Yu Q, Lin Y, et al. Global burden and trends of sexually transmitted infections from 1990 to 2019: an observational trend study. Lancet Infect Dis 2021; published online Dec 20. DOI:10.1016/S147-33099(21)00448-5. - DOI - PubMed
1. National Overview - Sexually Transmitted Disease Surveillance, 2019. https://www.cdc.gov/std/statistics/2019/overview.htm (accessed Feb 1, 2022).
1. Marrazzo JM, Dombrowski JC, Mayer KH. Sexually transmitted infections in the era of antiretroviral-based HIV prevention: Priorities for discovery research, implementation science, and community involvement. PLoS Med 2018; 15: e1002485. - PMC - PubMed

Publication types

Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

The HIV and sexually transmitted infection syndemic following mass scale-up of combination HIV interventions in two communities in southern Uganda: a population-based cross-sectional study

Collaborators

Affiliations

The HIV and sexually transmitted infection syndemic following mass scale-up of combination HIV interventions in two communities in southern Uganda: a population-based cross-sectional study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical